A 21-year-old woman prese...

A 21-year-old woman presented to a dermatology clinic for evaluation of a 1-month history of a painful mass on the right buttock and bilateral upper eyelid swelling. Her comorbidities included beta thalassemia trait and obesity. Vitals were normal O/E. A subcutaneous mass which was 5 by 2 cm in diameter, tender, firm, and fixed with a smooth surface was palpated over the upper outer quadrant of her right gluteal area. Bilateral upper eyelids were erythematous, non-tender, and swollen. Histological findings demonstrated nodular and diffuse inflammatory cell infiltrates in the dermis and subcutaneous tissue. The proliferative index marker (Ki67) showed variable positive ranging from 5 to 20%. Based on the clinical picture, histology and immunohistochemical studies, the diagnosis of SPTCL (α/β T-cell subtype) without hemophagocytic lymphohistiocytosis was made. Treatment with dexamethasone (40 mg/day) and ciclosporin A (200 mg/day) was started orally. Her lesions on bilateral eyelids resolved completely within 2 weeks; however, she developed generalized myalgia and a burning sensation in the epigastric area. Since then, dexamethasone was suspended and she was treated with only ciclosporin A at the same dose. At the follow-up visit after 7 months of receiving the medications, the lesion turned out to be about the same size and tender. Ciclosporin was discontinued and hydroxychloroquine (200 mg/day) was administered. The lesion resolved within 3 months and no recurrence was detected during the following 6-month follow-up.